Hypertension is a common chronic disease and the most important risk factor for cardiovascular and cerebrovascular disease. Among all types of hypertension, early morning hypertension is often overlooked, but it is no less harmful. Many people with hypertension believe that taking one blood pressure measurement during the day every day is sufficient, but it is not.
A single measurement during the day often does not reflect the true blood pressure level and does not reveal the signs of early morning hypertension. Therefore, many hypertensive patients think that their blood pressure is well controlled, but they do not know that the “volcano” of hypertension is hidden around them in the early morning and can “erupt” if they are not careful.
What is early morning hypertension?
Early morning blood pressure can be defined as any of the following.
1. home blood pressure measurements taken within one hour of waking up in the morning, before taking medication, and before breakfast.
2.Blood pressure recorded by ambulatory blood pressure 2 hours after waking up.
3, blood pressure between 6:00 and 10:00 am.
Early morning hypertension is defined as home blood pressure ≥135/85 mmHg and/or office blood pressure ≥140 mmHg.
Why does early morning hypertension occur?
Early morning hypertension results from the diurnal pattern of blood pressure. Blood pressure is controlled by the body’s biological clock and is constantly changing over a 24-hour period. Even in people with normal blood pressure, the blood pressure level also shows a more obvious circadian rhythm, which can be simply summarized as “two peaks and a valley”.
1, early in the morning, after waking up and getting up, from 8:00 to 10:00, blood pressure rises significantly, showing a peak, and then falls.
2.In the afternoon, from 17:00 to 18:00, blood pressure rises again from a trough to a peak.
3. At night, from 2:00 to 3:00, blood pressure is at its lowest, with another trough, and so on.
Under physiological conditions, the systolic and diastolic blood pressure when awake usually increases by 10% to 20% compared to sleep, and if the rise is too great, it is pathological and harmful to the human body and should be taken seriously.
The dangers of early morning hypertension
1, early morning blood pressure can be elevated to the heart, brain, kidneys and blood vessels and other serious damage.
2, early morning hypertension is the primary risk factor for the high incidence of cardiovascular and cerebrovascular events, and it is more important to control early morning blood pressure in the Asian population. Epidemiological surveys show that about 40% of myocardial infarction and 29% of sudden cardiac death occur in the early morning hours.
Early morning hypertension is also the strongest independent risk factor for stroke, with the incidence of stroke three to four times higher than during other times of the day. Therefore, stroke patients or people at high risk of stroke should especially control their blood pressure in the early morning.
4. The relative risk of carotid atherosclerosis increases fivefold in patients with early morning hypertension. It may also aggravate the kidney function damage in patients with chronic kidney disease.
However, about 60% of patients whose office blood pressure is controlled in China, early morning blood pressure is not well controlled and is basically a blind spot for blood pressure management. Therefore, it is imperative to recognize and manage early morning hypertension.
How to manage
In general, the occurrence of early morning hypertension is more often the result of poor blood pressure management, in addition to its own pathophysiological causes, excessive sodium intake, smoking, alcohol, diabetes and other risk factors. Achieving early morning blood pressure means that the 24-hour blood pressure standard is met, and early morning blood pressure is a better predictor of stroke risk than nighttime blood pressure. Therefore, it is especially important to manage early morning blood pressure well. We can do this in a number of ways.
1. Measure blood pressure correctly
The methods of monitoring include home blood pressure monitoring, 24-hour ambulatory blood pressure monitoring, and in-office blood pressure monitoring. When conditions allow, two or three methods can be used in combination to more accurately grasp the blood pressure management situation.
The scientific way to measure blood pressure should be within one hour after waking up, usually between 6:00 and 10:00 a.m.; before taking medication and before breakfast if possible; and before taking blood pressure measurement, empty the bladder and take a sitting position if possible.
For elderly patients with hypertension, in order to prevent postural hypotension, in addition to monitoring the sitting early morning blood pressure, also measure the blood pressure while standing or lying down.
2. Daily blood pressure management in patients with early morning hypertension
As with the general treatment of hypertension, three “restrictions” and four “insistences” should be emphasized when dealing with early morning hypertension: limiting exercise intensity, limiting salt (less than 6 grams per day) and fat intake, limiting smoking and alcohol consumption; insisting on regular medication, insisting on blood pressure measurement, insisting on regular follow-up, and insisting on a good state of mind and adequate sleep.
But the treatment of early morning hypertension also has its special characteristics.
(1) Drug taking
Reasonable and standardized use of antihypertensive drugs is the key to effective management of early morning blood pressure, and the best blood pressure control program should be to ensure that the antihypertensive efficacy covers the entire 24 hours. If early morning hypertension is still poorly controlled after taking the medication, it can be switched to a long-acting antihypertensive drug once daily under the guidance of a physician.
The timing of the medication can also be adjusted according to the early morning and nighttime blood pressure under the guidance of the physician for better control of early morning blood pressure. Combine medications or use compounded preparations if necessary.
(2) Exercise in the morning
Patients with early morning hypertension have an increased risk of cardiovascular events after early morning exercise compared to other times of the day compared to the healthy population or to patients with hypertension in general. Therefore, it is important to avoid strenuous activity between 6:00 and 10:00, and it is recommended that it would be safer to schedule exercise in the afternoon or evening.
For patients who must insist on morning exercise, short-acting antihypertensive drugs, such as nifedipine, can be taken after rising in the morning under the guidance of physicians to improve the safety of morning exercise. The elderly should pay special attention to the fact that they should not get up immediately after waking up in the morning, and their activities should not be too strong after getting up, and they should gradually transition from small amounts to their daily work life.
(3) “Three things to know
Knowing that controlling early morning hypertension is crucial and can effectively reduce cardiovascular events.
Knowing that insisting on measuring home blood pressure early in the morning before taking medication and recording it accurately, and bringing it to the doctor at follow-up appointments.
Know to insist on taking long-acting antihypertensive drugs early in the morning every day and instruct patients on the correct way to measure early morning blood pressure at home.
The “plan of the day lies in the morning”, so that blood pressure “pleasant and smooth” through the day should start from paying attention to early morning blood pressure.
In conclusion, for patients with hypertension, especially elderly patients with hypertension, they should develop proper early morning blood pressure monitoring habits, choose and insist on taking adequate doses of long-acting antihypertensive medications, and pay attention to lifestyle, diet structure, exercise habits and other adjustments.